Evidence map›Paper›PMID 41276771›Full record

ArticleAnnals of surgical oncology2026

Radiation De-Escalation in Older Women with Early-Stage ER+/HER2- Invasive Breast Cancer.

Ton Wang, Drew Neish, Samantha Thomas, Astrid Botty van den Bruele, Laura H Rosenberger, Akiko Chiba, Kendra Parrish, Lesly A Dossett, Gayle DiLalla, Jennifer K Plichta and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Ton WangDepartment of Surgery, Duke University Medical Center, Durham, NC, USA. ton.wang@duke.edu.ORCID http://orcid.org/0000-0003-0437-3771
Drew NeishDuke Cancer Institute, Duke University, Durham, NC, USA.
Samantha ThomasDuke Cancer Institute, Duke University, Durham, NC, USA.
Astrid Botty van den BrueleDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Laura H RosenbergerDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Akiko ChibaDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Kendra ParrishDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Lesly A DossettDepartment of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
Gayle DiLallaDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Jennifer K PlichtaDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Maggie L DiNomeDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
E Shelley HwangDepartment of Surgery, Duke University Medical Center, Durham, NC, USA.
Diandra Ayala-PeacockDepartment of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.

Funding

Women's Cancer Research ProgramP30CA014236 · NCI · DUKE UNIVERSITY · PI Laura Fish · 1985 to 2026
$174.8M
NCI NIH HHS P30 CA014236NCI NIH HHS P30CA014236
6 · The paper itself

Abstract

backgroundNational recommendations since 2004 have allowed for omission of post-lumpectomy radiotherapy for patients ≥70 years old with early-stage estrogen receptor positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer. Rates of omission in the era of abbreviated radiotherapy regimens are unknown. This study aimed (1) to determine contemporary trends in post-lumpectomy radiotherapy omission, (2) to determine trends in use of partial-breast (PB), ultra-hypofractionated (UHF), moderately hypofractionated (MHF), and conventionally fractionated (CF) radiotherapy regimens, and (3) to identify targetable factors to de-escalate radiotherapy in patients eligible for omission.

methodsA retrospective cohort analysis was performed using the National Cancer Database. The study identified patients ≥70 years old with pT1, cN0 pNX-0, cM0 ER+/HER2- breast cancer who underwent lumpectomy from 2012 to 2021. Radiotherapy treatment strategies based on number of fractions received were evaluated and compared using multivariable analysis.

resultsThe study included 121,160 patients: 51.0 % with no radiotherapy, 8.4 % with PB, 4.1 % with UHF, 30.2 % with MHF, and 6.3 % with CF radiotherapy. Radiotherapy omission decreased from 53.7 % to 46.8 % between 2012 and 2021. Whereas MHF radiotherapy doubled from 16.4 % to 32.9 %, CF radiotherapy decreased from 17.1 % to 2.0 %. A minority of patients received PB or UHF radiotherapy, although the rate of UHF increased from 4.6 % to 7.7 % between 2020 and 2021. Treatment at academic/research or Integrated Network Cancer Program facilities and higher-volume hospitals was associated with increased likelihood of treatment with abbreviated radiotherapy regimens.

conclusionsDespite efforts to promote treatment de-escalation, rates for omission of post-lumpectomy radiotherapy have decreased over time. To avoid overtreatment, patients who are eligible for omission but opt to receive radiotherapy should be considered for PB or UHF radiotherapy regimens.

Indexed as

Breast NeoplasmsErb-b2 Receptor Tyrosine KinasesAgedAged, 80 and overFemaleFollow-Up StudiesHumansMastectomy, SegmentalNeoplasm InvasivenessPrognosisRadiation Dose HypofractionationRadiotherapy, AdjuvantReceptors, EstrogenRetrospective StudiesERBB2 protein, humanErb-b2 Receptor Tyrosine KinasesReceptors, EstrogenAbbreviated radiotherapyBreast cancerDe-escalationHypofractionationRadiation omission

Identifiers

PMID41276771
PMCPMC12901127

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.